Welcome to the paradoxical world of Type A behavior. Nearly 30 years after this personality pattern was first linked to an increased risk of developing heart disease, a study in the Jan. 14 NEW ENGLAND JOURNAL OF MEDICINE concludes that hard-charging Type A men may be more likely to survive a second heart attack than their easygoing Type B counterparts.

"We struggled considerably with this finding," says epidemiologist David R. Ragland of the University of California at Berkeley, who conducted the study with Berkeley statistician Richard J. Brand. "But I would tend to say that Type A behavior is less likely [than was believed] to be important as a risk factor for dying from coronary heart disease."

In an editorial accompanying the report, psychiatrist and Type A researcher Joel J. Dimsdale of the University of California at San Diego says the findings show that Type A behavior is not linked to coronary heart disease in a simple, consistent way. Still, he notes that "something is going on . . . between personality and heart disease."

Researchers originally characterized Type A individuals as intensely competitive, impatient, controlling and ambitious, often bereft of clear goals. Type Bs, on the other hand, were said to be relaxed, cooperative and content. In the past decade, other aspects of Type A behavior--including hostility, cynicism and depression--have been explored as key promoters of heart disease.

The Berkeley researchers focused on the initial group of Type A and Type B men studied in the 1960s, 257 of whom had developed heart disease by 1969. Equal proportions of Type A and Type B subjects died suddenly of their first heart attack, a surprising finding in itself. But over the next 13 years, the 160 surviving Type As were only 58 percent as likely to die of another heart attack as the 71 surviving Type Bs. The lower mortality rate held for both younger (ages 39 to 54) and older (ages 55 to 70) Type As who survived an initial heart attack.

Ragland and Brand suggest that Type A patients may be more likely to comply with medical treatment or change their behavior after a heart attack. Type As may also pay closer attention to telltale cardiac symptoms and seek medical care earlier than Type Bs, they say.

However, cardiologist Meyer Friedman of Mt. Zion Hospital in San Francisco, co-director of the original Type A research, says the new data may be based on antiquated diagnoses. Many physical signs of Type A behavior, such as facial tics, rapid blinking, rushed speech and fist clenching, were not known when subjects in the study were diagnosed in 1960, says Friedman. The early interviews tested mainly for impatience, but not for hostility, he adds. According to Friedman, all of the men now would be diagnosed as Type As.

"I think [Ragland and Brand's] study is a disservice," he says.

Friedman's follow-up study, reported in 1975, found that over 8 1/2 years, Type A individuals had roughly twice the chance of developing coronary heart disease as Type Bs, regardless of other risk factors such as cigarette smoking. In more recent work, he has found that men who modify their Type A behavior through group counseling are at a reduced risk for developing heart disease (SN: 8/18/84, p. 109).

But Ragland and his colleagues contend that their findings suggest that efforts to enhance Type A survival through psychotherapy and behavior change may not be called for.

And Friedman's former collaborator, cardiologist Ray Rosenman of SRI International in Menlo Park, Calif., says the Berkeley researchers are on the right track. Furthermore, he contends that the original interviews picked up hostility as well as impatience, thus making the diagnoses accurate.

"But we only have hypotheses as to why Type As survive better," says Rosenman. It may be, he notes, that Type As are more willing to change after a first heart attack. Possible risks in the more passive, relaxed approach of Type Bs have not been closely examined, he adds.

Rosenman and his co-workers are now analyzing follow-up data from about 2,000 men included in the 1960 study to see if, among other things, Type As suffer more heart attacks than Type Bs, although men in the former group are more likely to survive.

In the last five years, says Brand, more studies have appeared showing no relation between Type A and heart attack risk. "This," he says, "has become a very confusing area of research."

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